Background Brief

Global health has emerged as a growing field, particularly over the past decade.  Greater recognition of the global AIDS crisis, combined with the appearance and rapid international spread of epidemics such as SARS and H1N1 (swine flu) have reinforced that health threats transcend national borders.  While much of the media attention has focused on epidemic infectious diseases, global health also encompasses a wider scope of health problems, determinants, and solutions, such as chronic illnesses and injuries, development, and foreign aid.  Advances in technology and communication make it difficult to ignore health problems in other parts of the world and easier to share medicines, interventions, and knowledge to find solutions. 

This issue module describes major trends, players, and financing issues in the area of global health and provides links to key organizations and resources for further study.

What is Global Health?

The term global health does not have one uniform definition.  Several organizations have defined the term, and they generally use it in three different ways: (1) as a state or condition; (2) as a goal; and (3) as a field of study, research, and practice. 

Definitions that frame global health as a state or condition refer to health issues that concern many countries or are affected by transnational determinants, such as urbanization, or solutions, such as polio eradication. [1]   For example, the Institute of Medicine (IOM) defines global health as “Health problems, issues, and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions.” [2]  According to this definition, the term goes beyond the perspectives and concerns of individual nations, races/ethnicities, social classes, and cultures to encompass the health of people all over the world.

Second, the term global health refers to the goal of improving health and achieving equity in health for all people worldwide.  Accomplishing such an objective requires that diverse stakeholders from different countries and disciplines, including those outside the health sciences, collaborate on approaches that combine population-based health promotion and disease prevention with individual-level clinical care. [3]  In line with this definition, the World Health Organization (WHO) states, “In the 21st century, health is a shared responsibility, involving equitable access to essential care and collective defense against transnational threats.” [4]

Finally, global health refers to a field of study, research, and practice that evolved out of 20th century programs in international health and the even earlier disciplines of hygiene and tropical medicine.  Whereas international health and tropical medicine relate more to health practices, policies, and systems in countries other than one’s own, especially in the developing world, global health stresses the commonality of health issues worldwide.  Increasing use of the term global health over international health reflects a shift in attitude that emphasizes a partnership and an exchange of experience and knowledge between developed and developing countries. [5]  National data shows that young adults are particularly interested in this growing field.  While four in ten Americans overall believe that increased spending from the U.S. and other developed countries will lead to meaningful progress in improving health for people in developing countries, more than half (56%) of young adults feel this is the case. [6]

Global Health Trends

The state of the world’s health has improved significantly in the last fifty years.  Globally, life expectancy has increased more during this time period than in the preceding 5,000 years. [7]  Similar improvements have been made in areas such as infant mortality and child health.  Factors that have contributed to gains in recent decades include: a higher standard of living; public health measures; new medicines and technologies; improved health literacy in a better-educated society; and easier diffusion of technologies and values such as human rights. 

However, this progress has not been equally distributed worldwide.  A considerable number of countries primarily in Sub-Saharan Africa and South-East Asia lag behind the rest of the world on many health indicators, including life expectancy, maternal mortality, and childhood underweight. [8]

While positive in many respects, urbanization, globalization, and demographic changes such as longer life spans have intensified timeless health problems and have resulted in the emergence of new health threats.  Although HIV/AIDS, tuberculosis, and malaria are three treatable and preventable diseases, they continue to have a devastating impact, especially in the world’s poorest countries.  Meanwhile, rich and poor countries alike are vulnerable to the spread of infectious diseases such as H1N1 and to the increase in risk factors for chronic diseases such as obesity.  Many developed countries have undergone an epidemiological transition in which noncommunicable diseases – including depression, diabetes, cardiovascular disease, and cancers – have replaced infectious diseases as the leading causes of morbidity and mortality.  Out of every 10 deaths worldwide, six are due to noncommunicable conditions, three to communicable diseases, reproductive issues, or nutritional conditions, and one to injuries. [9] 

Developing countries face a double burden.  Not only do their mortality patterns continue to reflect high levels of infectious diseases and the risk of death during pregnancy and childbirth, but many poor countries must simultaneously confront new challenges from chronic diseases.  In Africa, for example, smoking, elevated blood pressure and cholesterol are among the top 10 risk factors in terms of overall disease burden. [10]  At the same time, almost all those living with HIV (96%) reside in low- and middle-income countries, particularly sub-Saharan Africa. [11]  Severe resource constraints make it particularly difficult for less developed countries to deal with health problems.  Hence, the role of international donor assistance in less developed countries is critical.

The Millennium Development Goals

One framework for addressing global health challenges is the Millennium Development Goals (MDGs).  The MDGs were adopted by the Member States of the United Nations in 2000 to achieve demonstrable reductions in poverty and improve specific health and social outcomes by 2015.  The outlined goals reach beyond health issues, but three of the eight goals pertain directly to health:
     -Goal 4: Reduce child mortality
     -Goal 5: Improve maternal health
     -Goal 6: Combat HIV/AIDS, malaria, and other diseases

The MDGs reflect widespread acknowledgement that improving global health is an integral part of development.  However, the midpoint between 2000 and 2015 has passed, and the MDGs remain a distant goal for many countries.  For example, an estimated half-million women continue to die as a result of childbirth each year. [12]  While substantial progress has been made in child health, the global community needs to intensify and sustain efforts in other areas in order to meet the MDG targets. 

Major Players

There are many different types of players in global health operating at different levels.  Players include multilateral organizations, government agencies, non-governmental organizations, and local communities and individuals. 

Multilateral organizations bring together stakeholders from around the world to develop and collaborate on global health targets such as the MDGs.  The World Health Organization (WHO) is the principal multilateral organization involved in global health.  As the directing and coordinating authority for health within the UN system, WHO provides leadership for global health matters, including research, policy, and in-country technical support.  Other UN agencies such as UNAIDS and UNICEF focus on more specific global health issues such as AIDS and maternal and child health.  Multilateral organizations receive support primarily from Member States of the United Nations (UN), but they may also receive funding from private organizations and individuals.  Along with inter-governmental organizations, multilateral funding mechanisms such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Global Alliance for Vaccines and Immunization (GAVI) involve partnerships to streamline funding towards specific causes.   

Country-level assistance: While multilateral institutions play a critical role in facilitating worldwide cooperation on global health targets, many countries have government aid agencies that provide grants, loans, training, and technical assistance to improve global health and advance their own foreign policy priorities.  While both developed and developing nations support global health activities, the bulk of donor government assistance comes from the Group of Eight (G8) industrialized nations—Canada, France, Germany, Italy, Japan, Russia, the United Kingdom, and the US. [13]  The US provides the largest commitment of any donor government, working through several federal agencies to promote global health by doing research and capacity building and providing financial and technical resources to international organizations as well as to other countries.

A multitude of Non-Governmental Organizations (NGOs) – including philanthropic foundations, secular private organizations, faith-based organizations, and private corporations – work on a diverse array of issues in the field of global health.  Making up nearly 4% of funding for global health assistance in 2007, [14] the Bill & Melinda Gates Foundation tops the list of private foundations providing global health aid.  Other types of NGO’s work in both donor and recipient countries to advance global health through a wide range of mechanisms, including service provision, research, advocacy, economic and social development, education, and emergency relief. 

Local Health Care Communities: Finally, the health of people around the world relies on the day-to-day work of local health care communities and individuals.  The global health workforce includes, but is not limited to, health care providers, researchers, policy makers, educators, and advocates all working in different ways to improve the health of their fellow citizens.  Domestic governments may provide support to these local health care communities, but support varies greatly and depends upon income, debt, availability of external resources, and political commitment. [15]  

Financing Global Health

Funding is a major policy issue for global health.  In particular, the financial policies and practices of the wealthiest nations have important consequences in low- and middle-income countries.  These consequences are magnified during economic downturns, when lowered household income and reduced access to health care have negative effects on health.

Over the last decade, many countries have increased their financial commitments to global health.  For example, international AIDS assistance from the G8, European Commission, and other donor governments reached its highest level in 2008. [16]  The US is the largest donor to global health efforts in the world, although when measured as a percentage of GDP, it ranks 10th compared to other donor governments. [17]  While US funding for all major global health sub-sectors (HIV, TB, malaria, maternal and child health, family planning, and water) increased between FY 2004 and FY 2008, funding for HIV drove most of the increase (almost two-thirds) and accounted for the largest share of the budget (52% in FY 2008). [18] 

Despite the growth in funding from around the world to support global health activities, there is still persistent need around the world.  Securing the money needed to achieve global health equity has emerged as one of the world’s greatest challenges.  For example, the Global Fund to Fight AIDS, Tuberculosis and Malaria faces a funding shortfall of between US$4 billion and US$10 billion by the end of 2010. [19]  In addition, the global economic crisis has driven more people into extreme poverty, particularly women and children, thereby threatening progress towards the health-related MDGs.  Governments must weigh the short-term fiscal pressures to cut global health funding against the long-term human cost.  Additional resources from all sectors will be required to respond to the contemporary challenges of chronic and noncommunicable diseases and injuries.

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[1] Koplan, Jeffrey, T. Christopher Bond, Michael H. Merson, K. Srinath Reddy, Mario Henry Rodriuez, Nelson K. Sewankambo, and Judith N. Wasserheit, “Towards a common definition of global health,” The Lancet 2009, 373 (9679) 1993-1995.
[2] Institute of Medicine (IOM), Board on International Health, “America’s Vital Interest in Global Health: Protecting Our People, Enhancing our Economy, and Advancing our International Interests,” National Academy of Sciences, 1997.
[3] Kaiser Family Foundation, The U.S. Government’s Global Health Policy Architecture: Structure, Programs and Funding, April 24, 2009, p4.  
[4] World Health Organization, About WHO.
[5] Koplan, J. T. et al., “Towards a common definition of global health,” The Lancet 2009, 373 (9679) 1993-1995.
[6] Kaiser Family Foundation, Survey of Americans on the U.S. Role in Global Health, May 2009.
[7] Committee on the U.S. Commitment to Global Health, The U.S. Commitment to Global Health: Recommendations for the Public and Private Sectors, Institute of Medicine 2009, p2.
[8] World Health Organization, World Health Statistics 2009. 
[9] World Health Organization, World Health Statistics 2009. 
[10] World Health Organization, The World Health Report 2008: Primary Health Care Now More than Ever.
[11] Kaiser Family Foundation, “The Global HIV/AIDS Epidemic,” U.S. Global Health Policy Fact Sheet, April 2009.
[12] Dentzer, Susan, “The Devilish Details of Delivering on Global Health,” Health Affairs, July/August 2009, 28 (4). 
[13] Kaiser Family Foundation, Reporting Manual on HIV/AIDS, July 2009.
[14] Ravishankar, Nirmala, Paul Gubbins, Rebecca J. Cooley, Katherine Leach-Kermon, Catherine M. Michaud, Dean T. Jamison, and Christopher J.L. Murray, “Financing of Global Health: Tracking Development Assistance for Health from 1990 to 2007,” The Lancet 2009, 373: 2119.
[15] Kaiser Family Foundation, Reporting Manual on HIV/AIDS, July 2009.
[16] Kaiser Family Foundation and UNAIDS, “Financing the response to AIDS in low- and middle-income countries: International assistance from the G8, European Commission and other donor Governments in 2008,” July 2009.
[17] Kaiser Family Foundation, “The U.S. Government’s Global Health Policy Architecture: Structure, Programs and Funding,” April 24, 2009, p7.
[18] Kaiser Family Foundation, “The U.S. Government’s Global Health Policy Architecture: Structure, Programs and Funding,” April 24, 2009, p1.
[19] Kazatchkine, Michel, “Leading by Example – Protecting the most vulnerable during the economic crisis,” The Global Campaign for the Health Millennium Development Goals 2009.

Acknowledgements: Prepared by Grace Hunter and Usha Ranji of the Kaiser Family Foundation.

Updated: August 2009